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1April 21, 2005 IHE Patient Care Coordination

Patient Care Coordination, April 21th-22nd 2005

Charles Parisot,GE Healthcare IT

IHE IT Infrastructure Technical Committee Co-chair

Interoperability for Sharing Interoperability for Sharing Medical SummariesMedical Summaries

April 21, 2005 IHE Patient Care Coordination2

W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and VendorsWorking Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systemsin the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings


Standards Are CriticalStandards Are Criticalbut Alone Are Not Enoughbut Alone Are Not Enough

Managing the domain boundaries with mapping of information flow across boundariesStandards offer generality, ambiguity and alternativesStandards Implementation Guides are focused on a single standardVendor proprietary interestsComplexity!!

We need a standard process for how to We need a standard process for how to implement multiple standards!implement multiple standards!


Connecting Standards to CareConnecting Standards to CareCare providers must work with vendors to coordinate the implementation of standards to meet their needs

Care providers need to identify the key interoperability problems they faceDrive industry to develop and make available standards-based solutionsImplementers need to follow common guidelines in purchasing and integrating systems that deliver these solutions

What is the effective way to establish those What is the effective way to establish those ““standardsstandards”” for how to implement standards ?for how to implement standards ?


Prof. Societies Sponsorship

Healthcare Providers & Vendors

Healthcare IT StandardsHL7, DICOM, etc.

General IT Standards Internet, ISO, etc.

IHE Process

Driving healthcare standardsDriving healthcare standards--based integration based integration

IHE Integration Profile: A well-defined and tested solutionto a specific information exchange problem

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile


What is What is Integrating the Healthcare Enterprise ?Integrating the Healthcare Enterprise ?

IHE provides a common framework for passing health information seamlessly:

within the healthcare enterpriseacross multiple healthcare enterprisesfor local, regional & national health information networks.

IHE is sponsored by healthcare professional associations.

IHE drives standards adoption to address specific clinical needs.


IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE Oncology

New IHE Domains

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise

14 Integration Profiles

1 Integration Profile



Patient care coordination, Ophthalmology, Surgery, Pharmacy, Quality in 2005

Achievements and expanding scope15 Active national chapters on 4 continents, 4 Technical Frameworks

27 Integration Profiles, Testing at yearly Connectathons,Demonstrations at major exhibitions world-wide


Achievements and expanding scope15 Active national chapters on 4 continents, 4 Technical Frameworks

27 Integration Profiles, Testing at yearly Connectathons,Demonstrations at major exhibitions world-wide

Vendors claim compliance to IHE Integration Profiles by publishing an IHE Integration Statement for each product.

IHE

EHR- Longitudinal Record

IHE Cardiology

IHE Laboratory

IHE Radiology

IHE Oncology

Patient Care Coordination

IHE

IT Infrastructure Intra-Enterprise

Cross-Enterprise


1 Integration Profile



Medical Summary Document Content Integration Profile


A Proven Standards Adoption ProcessA Proven Standards Adoption Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEIHEConnectConnect--aa--thonthon

ProductWith IHE

IHEIHEDemonstrationDemonstration

User Site

RFPRFP

StandardsStandards(e.g. ASTM(e.g. ASTM--CCRCCR

HL7 CDA)HL7 CDA)

Product IHE IntegrationStatement

IHE Connect-a-thonResults

IHE Integration Profiles at the heart of IHE :Detailed selection of standards and options each solving a specific integration problemA growing set of effective provider/vendor agreed solutionsVendors can implement with ROIProviders can deploy with stabilityProcess started in1998 with continuous improvements

Requirements


The IHE Process for products in 2006 ? The IHE Process for products in 2006 ?

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEIHEConnectConnect--aa--thonthon

ProductWith IHE

IHEIHEDemonstrationDemonstration

User Site

RFPRFP

StandardsStandards(e.g. ASTM(e.g. ASTM--CCRCCR

HL7 CDA)HL7 CDA)

Product IHE IntegrationStatement

IHE Connect-a-thonResults

Requirements

AprilApril--May 2005May 2005MayMay--August 2005 ?August 2005 ?

January 2006 ?January 2006 ?

February 2006 ?February 2006 ?

Products Products 20062006


Massive yearly events :Massive yearly events :6060--70 vendors70 vendors120120--160 engineers160 engineersOver 100 systemsOver 100 systems…….integrated in 5 days.integrated in 5 days

IHE ConnectathonsIHE Connectathons

Vendors do not passVendors do not pass……until an IHE Project Manager attest it !until an IHE Project Manager attest it !


Participating and Contributing Vendors (America)Participating and Contributing Vendors (America)Agfa HealthCareAlgotec Systems, Ltd.BerdyCamtronicsCanon Medical SystemsCarefxCedara Software

CorporationCerner CorporationCSISTDictaphoneDR SystemsDynamic ImagingEastern InformaticsEastman Kodak CompanyEmageonEclipsysFujifilm Medical Systems

ProcomPhilips Medical SystemsRASNA Imaging SystemsSectraSentillionSiemens Medical SolutionsSoftmedicalStentor, IncStorCOMM, IncSwissray International, IncTiani Medgraph AGToshiba America Medical

SystemsUltraVisual Medical SystemsVital Images, Inc.Voxar LimitedWebMDXIMIS

GE HealthcareHeartlabHitachi Medical CorporationHologic, IncIDX Systems CorporationIMCO TechnologiesInSiteOneINFINITTKonica Minolta Marotech, Inc.McKesson Information

SolutionsMedconMedical Manager Health

SystemsMediface Co., Ltd.Merge eFilmMortara

In yellow, companies with IHE Committees Chairs (Summer 2004)

13April 21, 2005 IHE Patient Care Coordination

HIMSS 2005 HIMSS 2005 –– ShowShow--Wide InteroperabilityWide InteroperabilityVendor System

Ambulatory Showcase BoothAmbulatory Showcase Booth

HomeHome

PCP

MultispecialtyMultispecialtyClinicClinic

Diag Diag CenterCenter

CrossCross--enterprise Showcase Boothenterprise Showcase Booth

Cardiology

RadiologyIT

Infrastructure

In-Patient/Out-patient

VendorVendor BoothBooth







HL7 BoothHL7 Booth

AllscriptsCapMedCerner

EclipsysGE Healthcare

IDXInfinitt

InterSystemsKryptiq

MedCommonsMediNotesNextGenOpenTextSiemens

HIMSS “RHIO” withCross-enterprise

doc sharing


HIMSS 2005 InteroperabilityHIMSS 2005 InteroperabilityShow Case VendorsShow Case Vendors

Leadership LevelLeadership LevelCapMedCapMed//SanDiskSanDiskEclipsysEclipsysGE HealthcareGE HealthcareIDXIDXInterSystemsInterSystemsKryptiqKryptiqQuovadxQuovadx//CareScienceCareScienceSiemensSiemensWebMDWebMD

Participant LevelParticipant LevelAllscriptsAllscriptsCedara Cedara CernerCernerDictaphone Dictaphone Eastman KodakEastman KodakEclipsysEclipsysEmageonEmageonEpicEpicETIAMETIAMINFINITT Tech.INFINITT Tech.

MedcomSoft MedcomSoft MediNotesMediNotesMedCommonsMedCommonsMidMarkMidMarkMortaraMortara Instrument, IncInstrument, IncNational Institute National Institute ofof

Standards and TechnologyStandards and TechnologyNextGenNextGenNovellNovellOpen TextOpen TextSentillionSentillion

Supporter LevelSupporter LevelAccessPtAccessPt AGFAAGFA dbMotiondbMotion DinmarDinmar –– OacisOacisEMCEMC HealthvisionHealthvision HealthrampHealthramp McKessonMcKesson

ValcoValco Data SystemsData Systems


community

Clinical Encounter

Clinical IT System Index of patients records(Document-level)

Temporary Aggregate Patient History

4-Patient data presented to

Physician

Sharing SystemSharing System

33--RecordsRecordsReturnedReturned

Referenceto records

Clinic Record Specialist Record

Hospital Record

2-Referenceto Records for Inquiry

At HIMSS in 2005 : IHEAt HIMSS in 2005 : IHE--XDSXDS


community

Clinical Encounter




Referenceto records

Laboratory Results Specialist Record

Hospital Record


At HIMSS in 2005 : IHEAt HIMSS in 2005 : IHE--XDSXDS


Shared prototype content:• Medical Summaries (Pre-CCR)• Discharge Summaries (CDA-R1)• Lab Results (HL7)• Other (PDF)


community

Clinical Encounter


1-Patient Authorized

Inquiry



Referenceto records

Laboratory Results Specialist Record

Hospital Record


Demo a RHIO with IHE at HIMSS 2006 ?Demo a RHIO with IHE at HIMSS 2006 ?


Secured Sharing of:• Medical Summaries• Lab Results• Images & reports• ECG Reports• Other PDFs+ Notif of Doc Avail.


IHE Profiles for IHE Profiles for RHIOsRHIOsWhat is available and what needs to be added in 2005What is available and what needs to be added in 2005

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

Patient Demographics Query

Personnel White PageAccess to workforcecontact information

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

Notification of Document Availability

Notification of a remote provider/ health enterprise

Imaging Information Content

Format of the Document Content and associated coded vocabulary

For Display Document Content

Format of the Document ContentLab Results Document Content


Continuity of Care Document Content

Format of the Document Contentand associated coded vocabulary

Cross-enterprise User Identity and

AccountabilityAuthentication & Auditing: Basis for Access Control

Document Digital Signature

Attesting “true-copy and origin


IHE Profiles for IHE Profiles for RHIOsRHIOsWhat is available and what needs to be added in 2005What is available and what needs to be added in 2005

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

Patient Demographics Query

Personnel White PageAccess to workforcecontact information

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

Notification of Document Availability

Notification of a remote provider/ health enterprise

Imaging Information Content


For Display Document Content

Format of the Document ContentLab Results Document Content


Medical Summary Document Content

Format of the Document Contentand associated coded vocabulary

Cross-enterprise User Identity and

AccountabilityAuthentication & Auditing: Basis for Access Control

Document Digital Signature

Attesting “true-copy and origin

Medical Summary Document Content

Information Structure and Format of the Document Content

and Associated Coded Vocabulary


Patient Care CoordinationPatient Care CoordinationBroad industry consensus that medical summaries are the most critical clinical content building block:

Promoted by physician associationsSupported by Standards development: CCR, CDAConfirmed by HIMSS IHE Interoperability ShowcaseSupport of EHR Vendors Association and CCHIT

The issue is no longer if, or when (ASAP) but what is the first step to deliver for clinical use in 2006 ?Need to define an interoperable content scope for “a medical summary document” that delivers:

A significant quality and efficiency step for practitionersA reasonable scope for vendors with existing EHR products A practical deployment, use and maintenance. Affordable !The capability for further richness and computer processing to be added in subsequent incremental steps


Launching Patient Care CoordinationLaunching Patient Care CoordinationSuccess Factors:

Clear physicians and nurses leadership and sponsorshipAvailability of standards and support of developersWillingness of EHR Vendors to implement resulting integration profileInterest of Certification Commission to leverage resulting integration profile

Is Schedule too aggressive ?IHE has 7 years of experience and success in such efforts with aproven process spanning from integration profile to implemented productsSeveral years of Standards investments in ASTM and HL7 with rapidly maturing standards, near-ready to be used.We have the car, we need a determined team of care providers to lead the process.


Success depends on CollaborationSuccess depends on CollaborationProviders need confidence that EHR will support medical summaries consistentlyPatients need confidence that most current information is available and reusable.Vendors need confidence that providers will be satisfied Healthcare policy and financers need confidence that quality and efficiency will improve.

1+1+1+1 = 10


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and VendorsWorking Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systemsin the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings

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